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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients who have an interruption of the small bowel with a high enterostomy usually need parenteral supply or reinfusion of chyme to maintain nutritional and electrolytic balances before restoring intestinal continuity. Ten patients (aged 28-76 years) with a terminal jejunostomy located within the first meter of jejunum were treated by infusion of an elemental diet into the distal small bowel (IEDDSB). In addition, five of these patients had an extensive small bowel resection. IEDDSB was started 32 days after operation and lasted 4 to 8 weeks. Mean daily caloric infusion was 1,732 +/- 666 kcal diluted in 2,860 +/- 808 ml; mean associated oral intake was 1,187 +/- 480 kcal/24 hr, and jejunal fecal losses averaged 3 kg per day. IEDDSB was well tolerated in 4 patients; 5 experienced transient abdominal pain or diarrhea; 1 developed severe and protracted diarrhea. Biological cholestasis was seen before IEDDSB and persisted in most patients; 1 patient developed biliary sludge. Through IEDDSB, nutritional status improved or remained satisfactory in 9 patients, and worsened in 1 patient with sepsis and a short lower intestine. Mean body weight, triceps skin fold, muscle circumference, serum albumin, serum transferrin did not change significantly. Digestive nitrogen balance performed in 6 patients showed a net absorption between 5 and 15 g/24 hr. Fluid and electrolyte balance was maintained in 9 patients and 1 received iterative intravenous saline. Digestive sodium balance showed a net absorption rate greater than 60 mmol/24 hr. in all patients, except the one who required intravenous supply. Postoperative recovery was uneventful in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Elemental feeding into the distal segment of a temporary small bowel]. 210 16

To evaluate the efficacy of supplemental arginine with nutritional support in the presence of sepsis, eighty-eight gastrostomized female Hartley guinea pigs were implanted with osmotic pumps effusing an Eschericia coli/Staphylococcus aureus mixture. Animals were randomized and infused for two weeks with isocaloric and isovolumetric diets containing 0%, 2%, 4%, or 6% supplemental arginine as arginine hydrochloride. Survival was 12/22 (54%) in 0%, 9/22 (41%) in 2% and 4%, and 2/22 (9%) in 6%. Analysis by chi-square test of independence was significant (p = 0.0141) with 6% survival lower than the others. Median survival was 11 days in 0%, 8 days in 2% and 6%, and 9 days in 4%. Median survival was longer in 0% than in 2% or 6% (Kruskal-Wallis ANOVA: p = 0.02). Nitrogen balance was significantly lower in 6% compared to 0% on days 2 through 10, and lower than 2% and 4% on days 6 and 9. Nitrogen balance was higher in 0% than in 2% on days 4, 6, 10, and 13. Serum albumin and C3 were lower in all experimental groups than normal controls (ANOVA: p = 0.01). Comparison of liver, spleen, adrenals, gastrocnemius, and carcass weights, cell-mediated immunity as determined by contact sensitivity to DNFB, and transferrin showed no significant differences. There was a positive dose-response effect seen amongst the experimental groups for the amino acids arginine, ornithine, and citrulline in relation to the amount of supplemental arginine. This study suggests that dietary arginine supplementation does not enhance survival in a guinea pig model of established peritonitis.
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PMID:Arginine supplementation and its effect on established peritonitis in guinea pigs. 211 35

Most of the work of host defense has been carried out in mixed patient populations. It is now clear that elective preoperative surgical patients have totally different host defense capabilities as compared to posttrauma patients or those suffering from peritonitis. Specific cell-mediated immune studies need to be repeated in these 2 patient groups as well. What will contribute clinical relevance to these studies will be the means to correct the defects. If these defects or--more correctly termed--abnormalities of host defense are, indeed, important and contribute to an increased sepsis rate and mortality from sepsis in affected patients, then correcting them should reduce these complications. This hypothesis can only be tested when such means become available. The issues of most interest in the next few years will be the significance of serum albumin in host outcome, the role of immunomodulators, the involvement of cytokines in the overall process of host defense, and the use of specific nutritional support regimens targeted to the immune system.
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PMID:Systemic and peritoneal host defense in peritonitis. 218 80

Multiple extrapulmonary organ system failures increase mortality, permeability edema, and alveolar inflammation during gram-negative sepsis because of abnormal regulation of host inflammatory responses. We tested the hypothesis that acute hepatocytic injury induced by the selective hepatotoxin, D-galactosamine (GalN), augments mortality and amplifies pulmonary microvascular permeability to albumin and neutrophilic influx after administering Escherichia coli lipopolysaccharide (LPS) 24 h later by impairing the metabolism of endogenously synthesized products of arachidonic acid. We determined the lung extravascular leak of 125I-human serum albumin measured at multiple time points after LPS and enumerated polymorphonuclear leukocytes (PMNs) in bronchoalveolar lavage fluid (BALF). Because the liver is important in prostaglandin (PG) and leukotriene (LT) metabolism, we measured plasma concentrations of 6-keto-PGF1 alpha and thromboxane B2 (TxB2) in addition to paired plasma BALF concentrations of LTB4 and BALF LTC4 60 min and 24 h after LPS. We further assessed the protective effects of a single 20-mg/kg injection given intraperitoneally (i.p.) of the LTA4 synthetase inhibitor, diethylcarbamazine (DEC). After 400 mg/kg GalN, LPS at 2.5 or 1.25 mg/kg i.p. increased mortality (p less than 0.001), albumin leak 60 and 90 min after LPS (p less than 0.05), plasma 6-keto-PGF1 alpha, TxB2, and LTB4 levels and BALF LTC4 within 60 min (p less than 0.05). LTB4 and LTC4 levels in BALF 24 h later were similarly increased (p less than 0.05) as were bronchoalveolar PMNs (p less than 0.001). DEC improved mortality and albumin leak (p less than 0.001), reduced lung influx of PMNs and peripheral leukocytosis (p less than 0.05), attenuated plasma LTB4 and BALF LTC4 levels 60 min after LPS (p less than 0.05), and decreased BALF LTB4 and LTC4 at 24 h (p less than 0.05), but was associated with higher plasma 6-keto-PGF1 alpha and TxB2 values at 60 min. Changes in eicosanoid levels and modulation of responses by DEC in this model suggest that impaired metabolism of endogenously synthesized leukotriences by the damaged liver underlies these phenomena. We conclude that this mechanism may enhance septic lung injury during acute liver dysfunction.
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PMID:Effects of D-galactosamine-induced acute liver injury on mortality and pulmonary responses to Escherichia coli lipopolysaccharide. Modulation by arachidonic acid metabolites. 218 85

A human monoclonal antibody (HA-1A) directed against bacterial endotoxin was administered to 15 patients with incurable malignant disease. No adverse effects were noted following single intravenous infusions of 0.05 to 100 mg. Pharmacokinetics were evaluated in nine patients receiving 10 mg (n = 3), 25 mg (n = 3), and 100 mg (n = 3). Seven of these patients had initial peak serum concentrations greater than 80% of predicted values with plasma disappearance curves fitting a one-compartment system and a plasma half-life of 31.5 h (range of 20.3-44.6 h). The peak serum concentrations and area under the curve values were proportional to the dose of HA-1A administered. One patient had a hypercatabolic state with low levels of serum albumin and IgM. He achieved 65% of the predicted value for peak serum concentration of HA-1A with a plasma half-life of 12.3 h. A second patient had detectable serum HA-1A for only 15 min following infusion without an adequate technical or biologic explanation. We were unable to demonstrate antibody to HA-1A in sera from these nine patients either prior to therapy or during 28 days postinfusion using a "double-antigen" radiometric assay. This study suggests that HA-1A human monoclonal antibody administration is well tolerated by patients. Phase I trials will need to be carried out to characterize further the pharmacokinetics and toxicity of HA-1A in patients with gram-negative sepsis.
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PMID:Initial evaluation of a human immunoglobulin M monoclonal antibody (HA-1A) in humans. 234 60

We analyzed the treatment of a recent group of patients with life-threatening acute posterior mediastinitis due to esophageal perforation to elucidate common factors in successful treatment. Life-threatening acute posterior mediastinitis due to esophageal perforation was diagnosed in 16 patients over the past 12 years. Esophageal perforation resulted from endoscopy in 11 patients, retching in 4, and blunt trauma in 1 patient. Preoperative serum albumin levels were higher in patients who survived. Fourteen of 16 patients (88%) underwent exploration: mediastinal drainage in 14 (10 survived), esophageal repair in 9 (7 survived) with diversion in 3 (3 survived), and stent placement in 2 (1 survived). Six of 16 patients (38%) died, always of polymicrobial sepsis. Female patients and those with cancer, endoscopic perforations, delayed diagnosis, persistent mediastinal contamination, mediastinal suppuration or necrotizing cellulitis, and postoperative complications did poorly. Antibiotics must be effective against both gram-positive and gram-negative bacteria, and against both anaerobic and aerobic bacteria. Early surgical intervention is key, particularly elimination of ongoing mediastinal soilage. Thorough mediastinal debridement and wide mediastinal drainage appear to be important in improving survival of patients with life-threatening acute posterior mediastinitis due to esophageal perforation.
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PMID:Life-threatening acute posterior mediastinitis due to esophageal perforation. 236

We measured the delayed type hypersensitivity (DTH) skin test response, along with additional variables of host immunocompetence in 245 preoperative patients to determine which variables are associated with septic-related deaths following operation. Of the 14 deaths (5.7%), 12 were related to sepsis and in 2 sepsis was contributory. The DTH response (p less than 0.00001), age (p less than 0.0002), serum albumin (p less than 0.003), hemoglobin (p less than 0.02), and total hemolytic complement (p less than 0.03), were significantly different between those who died and those who lived. By logistic regression analysis, only the DTH skin test response (log likelihood = 41.7, improvement X2 = 6.24, p less than 0.012) and the serum albumin (log likelihood = 44.8, improvement X2 = 17.7, p less than 0.001) were significantly and independently associated with the deaths. The resultant probability of mortality calculation equation was tested in a separate validation group of 519 patients (mortality = 5%) and yielded a good predictive capability as assessed by (1) X2 = 0.08 between observed and expected deaths, NS; (2) Goodman-Kruskall G statistic = 0.673) Receiver-Operating-Characteristic (ROC) curve analysis with an area under the ROC curve, Az = 0.79 +/- 0.05. We conclude that a reduced immune response (DTH skin test anergy) plus a nutritional deficit and/or acute-phase response change are both associated with increased septic-related deaths in elective surgical patients.
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PMID:Estimating mortality risk in preoperative patients using immunologic, nutritional, and acute-phase response variables. 247 81

Early augmentation of a patient's immune system can be a valuable adjunct to standard supportive and antibiotic treatment of overwhelming postsplenectomy sepsis (OPSS). Normal humoral immune factors against pneumococcal sepsis are replenished by the parenteral administration of human gamma-globulin (HGG). Monthly prophylactic administration of HGG to asplenic individuals to prevent OPSS has been suggested. The cost of such measures is prohibitive, and the risk of serum-transmitted disease is significant. We administered HGG to splenectomized infant rats with pneumococcal sepsis to determine if mortality rates could be reduced and survival time prolonged. Fifty-six three-day-old rats underwent splenectomy and another 56, laparotomy without splenectomy. Twenty-eight animals from each operative group were administered HGG and the other 28, human serum albumin (HSA), 12 and 24 hours after inoculation with varying dosages of log-phase Streptococcus pneumoniae. The LD50 for asplenic animals was less than 50 colony forming units (cfu) per animal, while for the group with spleens, the LD50 was 250 to 500 cfu. There were no significant intragroup variations in LD50 between HGG and HSA subgroups. Survival times were compared using the BMDP1L-Life Tables and Survival Functions, and the generalized Wilcoxon t-test. These data show that host immunity to pneumococcal challenge in asplenic infant animals might be fully restored by the administration of HGG, even after the onset of symptoms. Survival of an asplenic child with evidence of OPSS might be enhanced by immediate administration of HGG.
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PMID:Gamma-globulin enhances survival in pneumococcal-challenged asplenic infant rats. 247 4

Sepsis with subsequent multiple organ failure is the commonest complication seen in the surgical intensive care unit today. A gut mucosal barrier dysfunction is assuming an increasingly important role as one possible explanation for the initiation of the septic process. It is known that the gut bacteria and endotoxins can, in the presence of a seemingly intact epithelium, translocate to extraintestinal sites, but the exact mechanism behind this process is not understood. In the present study we have approached this problem by testing the gut permeability to two macromolecules, bovine serum albumin (BSA) and fluorescein isothiocyanate (FITC)-dextran, after 7 days of enteral or parenteral nutrition in the rat. The plasma values of FITC-dextran after 4 h of marker feeding showed a significant increase in gut permeability after parenteral but not after enteral nutrition as compared with the controls. The plasma values of BSA, however, did not show any significant change in any of the groups. Thus, parenteral nutrition, with the changes occurring in the gut mucosa, may be one of the etiologic co-factors behind a gut mucosal barrier dysfunction, eventually leading to absorption of noxious agents into the systemic circulation with subsequent multiple organ failure.
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PMID:Increased gut permeability to fluorescein isothiocyanate-dextran after total parenteral nutrition in the rat. 247 82

During a 2 year period, 229 non-intensive care patients received total parenteral nutrition (TPN) for a mean of 23.2 days. Nutritional parameters of weight, triceps skin-fold thickness (TSF), mid-arm muscle circumference (MAMC), total lymphocyte count (TLC), serum albumin and serum transferrin were measured prior to commencement of TPN and then at weekly intervals. All parameters showed an upward trend during the period of TPN. This was small and not statistically significant for weight, TSF, MAMC and albumin; the trends were greater and statistically significant for transferrin (P = 0.001) and TLC (P = 0.002). In contrast, in the 14.4% of patients who died, albumin, transferrin and TLC all fell. Patients who died had a significantly lower initial albumin (P = 0.05), transferrin (P = 0.04) and TLC (P = 0.04). The last values obtained in patients who died were very significantly lower for albumin (P less than 0.001), transferrin (P less than 0.001) and TLC (P = 0.003). Single-lumen tunnelled subclavian catheters had a significantly lower incidence of catheter sepsis (4.8%) compared with double-lumen (17.4%) and triple-lumen (13.7%) catheters (P = 0.01). There was also a greater incidence of mechanical and thrombotic complications with multiple-lumen catheters compared with single-lumen catheters (P = 0.02). This study shows that the nutritional indices albumin, transferrin and TLC have prognostic significance. Single-lumen rather than multiple-lumen catheters should be used for administration of TPN whenever possible.
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PMID:A 2 year experience of a nutritional support service: prospective study of 229 non-intensive care patients receiving parenteral nutrition. 249 78


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